Can anyone point me to the studies that underpin the advice to not wean before six months?

[Arrtttiiieee]

I asked my HV and she said the six months advice is based on one EU study that she believes is flawed. Does anyone know where I can find the evidence base on which the six month advice is based?

The WHO advise waiting till 6 months. I found the paper online a while ago and it quoted the studies on which the advice was based.

Your HV is wrong - you can send her this link

summaries.cochrane.org/CD003517/optimal-duration-of-exclusive-breastfeeding

You may already know, and she should definitely know, that the Cochrane database is the international standard for evidence-based health and interventions. The review related to the length of time babies are best off on breastmilk alone is based on quality studies.

If she demurs, ask her the study she is thinking of, and look it up yourself.

I bet the "study" the HV is talking about was the Daily Mail about a year ago?

I'm loving the love for Cochrane on this thread! Good work, people!

Kelpeed, happily, all the charts in use in the UK are based on data from breastfed babies, and this has been the case for a few years now.

The old UK charts were different from the US charts, and based on data from UK babies, whose feeding was not differentiated - but they would, largely, have been ff, you are right.

All UK HCPs are supposed to have been trained in this stuff, but it seems some stick to the old ways and old ideas :(

Aidan, your HV was sort-of-right :)

There was a scare a little while ago in the US, when some toddler milks were found to contain arsenic, because they were sweetened with corn syrup or rice syrup, and it was arsenic in these that was the culprit.

I don't think any UK formulas are sweetened in this way.

If you're in the UK, she shouldn't have been saying anything at all about arsenic!

Thanks all. That cochrane link is useful.

I'm trying to work out when to put DC3 on to solids. His sibling has coeliacs disease and some studies suggest those at high risk from coeliacs benefit from exposure to gluten before six months. Other studies suggest early weaning can lead to coeliacs. It's all rather confusing!

Arrtttileee, the australian government have updated their advice based on recent research and now recommend weaning between 22 and 26 weeks. There's quite a few studies now that suggest waiting until 6 months is not optimum but not sure whether this is because people weaning earlier use lower amounts of gluten, or whether this is the optimum time for priming the body. I have heard rumours that advice may be changing in this country at some stage based on the latest research. What does your paediatrician suggest?

yetanother, you say "There's quite a few studies now that suggest waiting until 6 months is not optimum"....I don't think so!

The only thing I can think of is the editorial discussion document by Fewtrell in 2011, which raised the possibility that for some babies, it would be ok to give solids sooner, and noted that culturally, earlier-than-six-months is normal, and that the public health guidance of 6 mths should be more flexible. In fact the public health guidance already allows for flexibility, with a lower age of 17 weeks for babies who seem to need solids or for parents who for some reason can't bear to hold off a moment longer than necessary :)

www.bmj.com/content/342/bmj.c5955

It is not 'a study'.

The other thing you might have come across is the EAT study, yet to be completed, www.eatstudy.co.uk/, which looks at allergy and age of solids...it won't report its results for ages yet.

So far from 'quite a few', we actually have nothing at present which goes anywhere near overturning the Cochrane review. Even if the EAT study shows that early solids helps prevent allergy and of course it may not, it would still have to be considered in the context of other research supporting 6 mths as the optimum time for exclusive bf.

In the UK, any 'rumours' are spurious. SACN (the govt. committee of experts who look at nutrition and public health) have this under continuous review, as of course they should do, but they are unlikely to change their recommendations with no evidence.

Of course if I have missed the 'quite a few studies', then tell me!

PS There is a recent study which looks at infants at increased risk of diabetes, and suggests they have solids between 5-6 mths. That has not been generalised out.

Can you send a link to the Australian guidance changes? This has passed me by. Google only gives links to documents stating 'around 6 mths'.

Tiktok, this is the study that made me consider weaning early. It suggests that when Sweden changed its weaning guidance to six months more children developed coeliacs

sciencenordic.com/counter-coeliac-disease-early-glutens

Sorry but I can't be bothered trawling through loads of papers but there is the norwegian study www.ncbi.nlm.nih.gov/pubmed/23182171 which I think is one of the best studies but there are a few other papers looking at various illnesses and timing of introduction of solids.

The NHMRC is still at draft stages www.ncbi.nlm.nih.gov/pubmed/22472685. Sorry I've been chatting to someone involved in these guidances and hadn't realise that they hadn't been formalised yet.

I think the EAT study will throw up some interesting data and hope that they publish sooner rather than later.

I'm sorry, yetanother - you are not being clear. You have linked to studies on allergy which is only one aspect of health, albeit an important one. When the 'optimum age' is looked at, it would be essential to look at all aspects of health and growth, which is what the Cochrane review did. I am correct, I think, that there have been no studies that indicate overall that 6 mths is not good guidance.

Thanks for checking on the Australian guidance. You got that wrong, too.

Maybe it will emerge with further studies that public health guidance should change. But we certainly don't have the evidence to do so at present.

I didn't say we have the evidence at the moment, just that there is a lot of evidence coming from developed countries suggesting that introducing solids at 6 months may not be beneficial to long term health. That paper is just one that I was shown earlier this week. If you do a Pubmed search there are many papers from the last couple of years that indicate optimum time to prevent allergies/gluten intolerance etc is between 4 and 6 months.

Allergies is an important topic area, but as I explained, yetanother, this is not the whole of child health. There is concern in the developed world about allergy at present; the EAT study I mentioned before is an attempt to see if infant nutrition has an impact on the development of allergy. There are a number of papers in the same topic area.

But any public health guidance needs to look at all aspects - growth, overall nutrition, infections - as well as allergy.

Current guidance should not be overturned lightly - it should be based on decent evidence from a range of studies which look at more than just allergy.